Director – Credentialing & Enrollment Services
Neolytix
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Job Level
About the role
- Provide strategic and operational leadership over all provider credentialing, re-credentialing, and payer enrollment functions for healthcare clients.
- Develop and execute the strategic vision for credentialing and enrollment service delivery.
- Serve as the senior point of escalation for client concerns related to credentialing and enrollment timelines, quality, and outcomes.
- Lead client onboarding and development of customized enrollment strategies.
- Build and maintain strong relationships with key client stakeholders.
- Oversee the end-to-end credentialing lifecycle and ensure compliance with credentialing standards and regulations.
- Direct all payer enrollment activities across commercial, Medicare, Medicaid, and managed care payers.
- Recruit, train, mentor, and manage a team of credentialing specialists and enrollment coordinators.
- Drive continuous process improvement initiatives and evaluate new technologies to enhance efficiency.
Requirements
- Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
- 5–7+ years of progressive experience in provider credentialing and payer enrollment, including management-level responsibility.
- Demonstrated experience managing credentialing/enrollment operations in a vendor, outsourcing, or multi-client environment.
- Deep working knowledge of NCQA credentialing standards, CMS enrollment regulations, and CAQH/PECOS/NPPES systems.
- Proven ability to manage and develop teams of 10+ credentialing and enrollment professionals.
- Strong understanding of the provider revenue cycle and the downstream impact of credentialing and enrollment delays.
- Proficiency with credentialing software platforms and Microsoft Office Suite.
- CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) certification through NAMSS preferred.
- Master's degree in Healthcare Administration (MHA), Business Administration (MBA), or related discipline preferred.
- Experience with delegated credentialing arrangements and payer delegation audits preferred.
- Familiarity with Lean/Six Sigma process improvement methodologies preferred.
- Experience supporting multi-state, multi-specialty provider organizations preferred.
- Knowledge of telehealth credentialing and interstate licensure compact requirements preferred.
Benefits
- Business Travel: Required
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
provider credentialingpayer enrollmentcredentialing lifecyclecompliance standardscredentialing software platformsLean/Six Sigmatelehealth credentialinginterstate licensure compactprovider revenue cycledelegated credentialing
Soft Skills
strategic leadershipoperational leadershipclient relationship managementteam managementprocess improvementmentoringcommunicationproblem-solvingclient onboardingstakeholder engagement
Certifications
CPCSCPMSM